| NPI | 1326050832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX G6559) |
| Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care (Licence: TX 75-2548578) |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2015-04-14 |